Psychiatry International

Recently dubbed Long COVID or Long-Haul COVID, those recovering from the initial COVID-19 infection may maintain clinical signs for longer than two or more weeks following the initial onset of the infection. The virus can gain entry into the CNS through axonal transport mediated through the olfactory nerve or hematogenous spread and can also cross the blood–brain barrier to access the temporal lobe and the brainstem. The neurologic and neuropsychiatric symptoms associated with COVID-19 patients are becoming a highly studied area due to the increased frequency of reported cases. Multiple hospital case series and observational studies have found a headache to be a common symptom among patients who are symptomatic with the SARS-CoV-2 virus. The headache described by many of these patients is similar to new daily persistent headache (NDPH). NDPH potentially develops in response to pro-inflammatory cytokines during a persistent systemic or CNS inflammation, mostly due to the initial infection. The treatments investigated were high-dose steroids, tetracycline derivatives, onabotulinum toxin type A, and long-term multidrug regimens. Among the identified symptoms of post-COVID-19 viral illness, fatigue appears to be the most ubiquitous. High-dose vitamin C is currently a suggested therapy proposed for its antioxidant, anti-inflammatory, and immunomodulatory properties. The mental health consequences of this diagnosis are being identified among large portions of COVID-19 survivors. Among these consequences, cases of major depressive disorder (MDD) and anxiety are being reported and closely examined. The aim of this narrative review is to highlight the neurological and psychiatric symptoms that have been associated with Long-Haul COVID and their possible treatments. Full article

Loneliness and, to a lesser degree, social support are considered under-researched topics in the literature on eating disorders (ED). This study attempted to expand the relevant body of research by examining loneliness in combination with social support in ED patients and in healthy controls (HC). Binge-eating problems, emotional eating, resilience, anxiety, and depression symptoms were also assessed. Thirty-two patients with ED and twenty-nine HC completed the following measures: UCLA Loneliness Scale, Social Support Questionnaire—Short Form, Binge Eating Scale, Emotional Eating Scale, Connor–Davidson Resilience Scale, Hospital Anxiety and Depression Scale, and the Eating Disorder Examination Questionnaire. Eating-disorder patients showed higher levels of loneliness and lower levels of social support—both in terms of perceived availability and satisfaction—than HC. Anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) subgroups did not differ significantly on either of these variables. In ED patients, loneliness was only correlated with Social Support Satisfaction (negatively) and depressive symptomatology (positively). Patients with ED appear to be lonelier and less satisfied with their social support compared to HC. We found similar levels of loneliness and social support between AN, BN, and BED sufferers. Decreased social support satisfaction and elevated symptoms of depression could account for ED patients’ high levels of loneliness. Full article

Introduction: Since the early 2000s, there have been extensive investigations into cognitive biases in addictive disorders. The advances in the field have led to the discovery that cognitive bias exists in substance disorders and could in turn be modified. To date, there have been primary studies and meta-analysis demonstrating the existence of these biases and the effectiveness of cognitive bias modification (i.e., whereby such biases are retrained). There remains a lack of understanding of how the field has progressed and the research gaps, in light of the evidences provided by these primary studies. Objectives: A bibliometric analysis of the publications to date was performed to provide a map of the work that has been done so far. This would help researchers to better understand the development of cognitive bias research, the direction of the research, and the recent trends. Methods: For the purposes of this bibliometric research, Web of Science (WOS) was used in the identification of relevant articles. To identify the relevant articles, the following search strategy was implemented, that of ((((((TS = (“cognitive bias”)) OR TS = (“attention bias”)) OR TS = (“approach bias”)) OR TS = (“avoidance bias)) OR TS = (“interpretative bias”))). Bibliometric data analysis was conducted based on the identified articles. Results: A total of 161 citations were eventually included. These citations were published between 1994 and 2022. The average number of citations per documents was 26.73. Of these 161 citations, 122 were articles, 2 were editorials, 3 were corrections to the original manuscript, 5 were reviews, and 29 were meeting abstracts. The analysis of the trend of topics has shown that researchers were focused on understanding and gaining insights into cognitive biases and potentially examining the association between cognitive biases and cravings and aggression in the early days. Over the years, there has been an evolution into examining specific unconscious biases, namely, that of attention and approach biases. In the most recent years, the investigations have been more focused on examining bias modification/retraining. Conclusions: From our knowledge, this is the first bibliometric analysis that has been undertaken to explore all the publications related to cognitive bias in the field of addiction. The insights gained from this article could inform future research. Full article

Parenting stress is affected by various factors, including maternal attachment; however, the number of studies focusing on Japanese samples is limited. As such, we explored the association between mothers’ attachment styles and parenting stress among Japanese mothers with 18-month-old toddlers. This cross-sectional study was conducted in Sasebo City, Japan between 2018 and 2019. Anonymous self-reported questionnaires were distributed to 1399 mothers who attended an infant health check-up. We categorized maternal attachment style as secure, anxious/ambivalent, or avoidant, and conducted a multiple logistic regression analysis to evaluate the associations between each attachment style and parenting stress. Of the 1399 mothers, 529 responded to the survey (37.8%). About 40% reported experienced parenting stress. Further, approximately two-thirds showed a secure attachment style, 20% had an anxious/ambivalent style, and 15% had an avoidant style. In the multiple logistic regression analysis, the ambivalently attached mothers had a significantly higher level of parenting stress than those with secure attachment (odds ratio = 2.4, 95% confidence interval (1.5, 3.9)), but avoidantly attached mothers did not have a significantly higher level of parenting stress than those with secure attachment (odds ratio = 0.9, 95% confidence interval (0.5, 1.6)). The findings demonstrate that an anxious/ambivalent attachment style is associated with a higher level of parenting stress than a secure style. Thus, it is important for experts to understand the mother’s attachment style when offering childrearing support. Full article

Bipolar disorder (BD) is a highly disabling condition with a chronic and relapsing nature. Despite the substantial socioeconomic burden associated with BD, there are still significant research gaps in risk stratification, diagnostic accuracy, and treatment selection, all key components of precision psychiatry. One possible strategy to increase the validity of precision psychiatry approaches in BD is to increase our knowledge of disorder-associated gut microbiota perturbations. To this end, we systematically reviewed the evidence on gut microbiota alterations in relation to precision psychiatry approaches on BD. We performed a systematic review on PubMed/MEDLINE and Web of Science to identify original articles investigating the possible clinical applications of microbiota analyses for pragmatic precision psychiatry in BD. A pearl growing strategy was employed to enlarge the scope of this review. The primary search strategy yielded one paper and an additional one was identified through reference tracking. The included studies were observational, with one study of good quality. The identified results justify the efforts devolved in this area of research and underscore the need to expand these investigations through additional larger and properly designed studies. Full article

The COVID-19 pandemic has been raging around the world and public health measures such as lockdowns have forced people to go out less often, reducing sunlight exposure time, green space use, and physical activity. It is well known that exercise has a positive impact on mental health, but the impact of external environmental factors such as sunlight exposure and green space use on mental health has not been systematically reviewed. In this review, we categorized the major factors that may affect people’s mental health into (1) external environmental factors such as exposure to sunlight and green spaces, (2) internal life factors such as physical activity and lifestyle, and (3) mixed external and internal factors, and systematically examined the relationship between each factor and people’s mental health. The results showed that exposure to sunlight, spending leisure time in green spaces, and physical activity each had a positive impact on people’s mental health, including depression, anxiety, and stress states. Specifically, moderate physical activity in an external environment with sunlight exposure or green space was found to be an important factor. The study found that exposure to the natural environment through sunbathing and exercise is important for people’s mental health. Full article

Even before COVID-19, university inductees were vulnerable to transitional stressors, which impact upon their psychological well-being and ability to complete their studies. Resilience, as a psychological construct, may be analogous to holding the functioning that supports higher-level academic performance in twenty-first century higher education (HE). Given the significant investment HE requires, coupled with students’ capacity to develop their resilience, universities may be expected to promote psychological resilience in new students. Linking HE to resilience, outdoor adventure (OA) residential programmes have enabled inductees to build components of resilience (i.e., increased self-perception, feelings of control, and intrapersonal relationships) that may heighten their immediate and longer-term academic performance. Yet, few studies have examined the sustainability of these effects. Across five annual cohorts, the self-perceived resilience of 2500 inductees was profiled across three time-point trajectories: (i) pre-OA programme, (ii) post-OA programme, and (iii) three months post-OA programme. Further, the functionality of inductees’ enduring resilience was evaluated for predicting their prospective academic performance at the end of their first year of study. Students’ self-perceived resilience, well-being, and positive recollection of OA experiences reflected their bounce-back ability and a healthy trajectory of productive functioning. Students reporting higher levels of resilience after three months of following the programme were more likely to achieve better prospective academic outcomes. The large sample size ensured that a powerful detection of change was established across time. However, given the absence of a comparison condition across all time points, any lasting improvements in students’ resilience was unable to be attributed to the OA programme. Nonetheless, the results give significant grounds for further research in this direction, including the study of more distinct narrative enquiries at follow-up. In this way, pedagogical practices, supporting effective interventions, may be deployed with incoming students, with the aim of building and maintaining students’ on-going resilience across different learning contexts. Full article

Neuroticism and premenstrual conditions share pleiotropic loci and are strongly associated. It is presently not known which DSM-5 symptoms of premenstrual syndrome/premenstrual mood disorder are associated with neuroticism. We enrolled 45 study participants to provide prospective daily ratings of affective (“depression”, “anxiety, “anger”, “mood swings”) and psychological (“low interest”, “feeling overwhelmed”, and “difficulty concentrating”) symptoms across two-three menstrual cycles (128 total cycles). Generalized additive modeling (gam function in R) was implemented to model the relationships between neuroticism and the premenstrual increase in symptomatology. Significance level was adjusted using the False Discovery Rate method and models were adjusted for current age and age of menarche. Results of the association analysis revealed that “low interest” (p ≤ 0.05) and “difficulty concentrating” (p ≤ 0.001) were significantly associated with neuroticism. None of the remaining symptoms reached statistical significance. The late luteal phase of the menstrual cycle is characterized by complex symptomatology, reflecting a physiological milieu of numerous biological processes. By identifying co-expression between neuroticism and specific premenstrual symptomatology, the present study improves our understanding of the premenstrual conditions and provides a platform for individualized treatment developments. Full article

Background: Individuals with physical or mental health conditions represent a vulnerable population, especially during the COVID-19 pandemic. However, limited information is available concerning posttraumatic growth and common mental health symptoms of this vulnerable health group during COVID-19. Methods: An online cross-sectional study (STRONG study; psychological changes and effects after COVID-19 quarantine in Greece) was conducted from 28 September 2020 (no lockdown restrictions) to 2 November 2020, just before the second lockdown in Greece. Main outcomes were depressive and anxiety symptoms as well as posttraumatic growth. Results: A total of 860 adults participated in the study. A high proportion of participants did not report any pre-existing health condition (61%), while 334 individuals reported one or more physical or mental health conditions. Overall, 20.2% of the participants reported significant depressive symptoms, and 27.9% reported moderate to high posttraumatic growth. The presence of physical and mental health conditions, either as single diagnosis or as a multimorbidity, was significantly associated with the development of depressive symptomatology (either physical or mental health conditions: OR = 1.12; 95% CI, 1.07–1.17, p < 0.001; both physical and mental health conditions: OR = 1.23; 95% CI, 1.14–1.33, p < 0.001). Posttraumatic growth did not differ between those with or without any pre-existing health issue. Conclusions: Although having a physical or/and a mental health condition predicted the development of depressive symptomatology in a post-lockdown period, the presence of pre-existing conditions was not associated with posttraumatic growth development. Clinicians should be aware of depressive symptoms among their multimorbid patients, even after exiting lockdown. Full article

Psychiatric disorders, in general, have a high prevalence of sexual problems, whether from the psychopathology of the disorder itself, pre-existing or co-morbid sexual disorder or from side effects of the treatment for mental disorders. Many patients report an already existing sexual dysfunction at the onset of diagnosis. The risk association for developing sexual dysfunction in patients with schizophrenia includes antipsychotic use and resulting hyperprolactinemia, age, gender, and disease severity. Medication side effects lead to nonadherence, and relapses lead to structural changes in the brain, treatment resistance, and worsening of symptoms. Findings in certain studies propose serum prolactin and thyroid-stimulating hormone measurement as a tool for assessing patients with schizophrenia for sexual dysfunction. Regarding specific symptoms, females especially reported decreased desire at baseline and galactorrhea after treatment. The findings of this review, therefore, suggest that sexual dysfunction may be present in patients with schizophrenia before starting antipsychotic treatment and that patients, especially those who are female, are likely to develop hyperprolactinemia with antipsychotic treatment. Aripiprazole may be an emergent treatment for sexual dysfunction in those who use antipsychotics. It is important for patients to consider sexual dysfunction prior to prescribing antipsychotics. Since sexual dysfunction can impact a patient’s quality of life and affect treatment adherence, it is important for physicians to be aware and monitor patients for symptoms. Full article

Attention-deficit Hyperactivity Disorder is one of the most common childhood mental health disorders, affecting about 5.6% of the population worldwide. Several studies have specifically shown a high prevalence of comorbid mood disorders, such as depression and bipolar disorder (BD), in those diagnosed with ADHD. Several common symptoms of ADHD are also found in BD, which are characterized by alternating periods of euthymia and mood disturbances. The inattention and impulsivity of ADHD can be seen in manic and hypomanic episodes of BD. Over the past decade, there has been an increased interest in research between the correlation of ADHD and pediatric bipolar disorder (PBD) in children. Some experts hypothesize that more children are comorbidly diagnosed with ADHD and PBD because of how many clinicians treat children with ADHD. Other factors, which may affect the dual diagnoses of ADHD and PBD, are overlapping diagnostic criteria for the two disorders, the inevitable biases seen when one disorder is diagnosed without the other, and related risk factors leading to prodromal relationships. By examining clinical trials, a better understanding of whether ADHD and PBD have a stepwise progression or if other factors influence these comorbidities, such as blurred lines of diagnostic criteria. Those with ADHD are also at an increased risk of impairment at work and in social settings. This manuscript explores both progression of this disease and its clinical connections to other disorders. Full article

Recently, several studies reported that the governmental financial expenditures play important roles in the prevention of increasing suicide mortalities; however, the specific regional policies, designed dependent on regional cultural, economic, education and welfare backgrounds, affect suicide mortality by a specific suicidal means. Therefore, the present study determined the impacts of the regional governmental expenditure of six major divisions, “public health”, “public works”, “police”, “ambulance/fire services”, “welfare” and “education” on suicide mortalities by five major suicidal means, “hanging”, “poisoning”, “charcoal burning”, “jumping” and “throwing”, across the 47 prefectures in Japan during 2009–2018 using fixed-effect analysis of hierarchal linear regression with robust standard error. The expenditures of “ambulance/fire services” and “education” indicated the negative relation to suicide mortalities by wide-spectrum suicidal means, whereas expenditures of “public works” did not affect suicide mortalities. In the education subdivisions, expenditure of “kindergarten” and “elementary school” indicated the impacts of reduction of suicide mortalities, whereas the expenditures of “special school” for individuals with disabilities unexpectedly contribute to increasing suicide mortalities by poisoning, charcoal burning and throwing of females. Regarding subdivisions of welfare, expenditure of “child welfare” and “social welfare” contributed to a reduction in suicide mortalities, but expenditure of “elderly welfare” surprisingly contributed to increasing suicide mortalities. Furthermore, expenditures of welfare subdivision abolished the negative impacts of the expenditures of educational subdivisions, kindergarten and elementary school, but the positive impact of expenditure of special school on female suicide mortalities was not affected. These results suggest that most Japanese people are struggling to care for children even in the situation of an increasing elderly population with a decreasing birthrate. Therefore, it is important to enhance the investment welfare policy for the future to improve the childcare environment. The results demonstrated by this study suggest that the scientifically evidence-based redistributions of welfare expenditure in regional government, at least partially, provide improvement of Japanese society and welfare systems, under the continuous severe Japanese social concerns associated with increasing elderly population with a decreasing birthrate. Full article

Objectives: To assess the causes and risk factors of post-traumatic stress disorder (PTSD) in adult asylum seekers and refugees. To explore whether the causes and risk factors of PTSD between male and female adult refugees/asylum seekers are different. Study design: Systematic review of current literature. Data Sources: PubMed, Web of Science, Scopus and Google Scholar up until February 2019. Method: A structured, systematic search was conducted of the relevant databases. Papers were excluded if they failed to meet the inclusion and exclusion criteria. Afterwards, a qualitative assessment was performed on the selected papers. Results: 12 Studies were included for the final analysis. All papers were either case studies/reports or cross-sectional studies. Traumatic events experienced by refugees/asylum seekers are the most frequently reported pre-migration causes of PTSD development, while acculturative stress is the most common post-migration stressor. There were mixed reports regarding the causes of PTSD between both genders of refugees/asylum seekers. Conclusions: This review’s findings have potential clinical application in terms of helping clinicians to risk stratify refugees/asylum seekers for PTSD development and thus aid in embarking on earlier intervention measures. However, more rigorous research similar to this study is needed for it to be implemented into clinical practice. Full article

Despite the extensive usage of the internet, little is known about internet addiction among Americans during the pandemic. A valid and reliable questionnaire was deployed online via MTurk to recruit a national sample of adult Americans to understand the nature and extent of internet addiction. A total of 1305 individuals participated in the study where the majority were males (64%), whites (78%), non-Hispanic (70%), married (72%), 18–35 years old (57%), employed full time (86%), and with a Bachelor’s degree or higher (83%). The prevalence of internet addiction was distributed as no addiction (45%), probable addiction or risk of addiction (41%), and definite or severe addiction (14%). More than a fourth of the population had depression (28%) or anxiety (25%). Despite adjusting for sociodemographic characteristics, definite/severe internet addiction was strongly predictive of depression, anxiety, and psychological distress in multiple regression analyses. Those who were probably addicted or at risk of addiction were also more likely to have depression or anxiety. Compared to estimates before the pandemic, this study suggests an increase in internet addiction among U.S. adults during the COVID-19 pandemic. Population-based interventions and mental health promotion strategies should focus on a reduction in internet consumption and screen time. Full article

Background: Because the prevalence of mental health concerns is high and access or full responsiveness to pharmacological or psychotherapeutic treatment for many individuals is low, there has been increased interest in yoga as a potential therapy for many mental health concerns. Approach: We synthesize and critique current research on the efficacy of yoga relative to pharmacological approaches for anxiety disorders, mood disorders, posttraumatic stress disorder, obsessive-compulsive disorder, and eating disorders. Results: Yoga has been tested mostly as a complementary treatment to standard psychiatric and psychotherapeutic approaches. Findings from efficacy trials largely support the notion that yoga can help reduce symptoms of many psychiatric conditions, including anxiety, depression, and PTSD symptoms, above and beyond the effects achieved by standard pharmacological treatments alone; however, most evidence is of poor to moderate quality. Plausible transdiagnostic bottom-up and top-down mechanisms of yoga’s therapeutic effects have been advanced but remain untested. Conclusions: While results should be considered preliminary until more rigorous evidence is available, yoga appears to have the potential to provide many people suffering with psychiatric symptoms additional relief at relatively little cost. Yoga may be a viable complementary therapy to psychiatric and psychotherapeutic approaches for people with mental health challenges. Full article

Dhat syndrome is a culture-bound syndrome, mostly prevailed in South East Asia that has been systematically defined approximately six decades ago. Assessment of the published literature would help to identify the research density as well as the gaps. We aim to do a bibliometric analysis of published global scientific literature on dhat syndrome. The Scopus database was systematically searched by using the keywords “Dhat syndrome”, “Semen loss syndrome”, “Semen loss anxiety” from inception to 11th August 2021. A total of 89 articles on dhat syndrome were found in the Scopus database. Most of the articles were from India and were published in the Indian Journal of Psychiatry and Asian Journal of Psychiatry. The majority (>58%) of research on dhat syndrome was published in the last decade. The PGIMER (Chandigarh), AIIMS (New Delhi) & KGMU (Lucknow) are the leading institutes in dhat syndrome research. The year 2004 had the highest number of total citations (n = 135), while the year 1975 had the highest number of citations per article (60 citations per article). This bibliometric review identified that despite dhat syndrome is a common condition in the South East Asian countries, research on the condition is limited. Full article

Opioid use disorder is a well-established and growing problem in the United States. It is responsible for both psychosocial and physical damage to the affected individuals with a significant mortality rate. Given both the medical and non-medical consequences of this epidemic, it is important to understand the current treatments and approaches to opioid use disorder and acute opioid overdose. Naloxone is a competitive mu-opioid receptor antagonist that is used for the reversal of opioid intoxication. When given intravenously, naloxone has an onset of action of approximately 2 min with a duration of action of 60–90 min. Related to its empirical dosing and short duration of action, frequent monitoring of the patient is required so that the effects of opioid toxicity, namely respiratory depression, do not return to wreak havoc. Nalmefene is a pure opioid antagonist structurally similar to naltrexone that can serve as an alternative antidote for reversing respiratory depression associated with acute opioid overdose. Nalmefene is also known as 6-methylene naltrexone. Its main features of interest are its prolonged duration of action that surpasses most opioids and its ability to serve as an antidote for acute opioid overdose. This can be pivotal in reducing healthcare costs, increasing patient satisfaction, and redistributing the time that healthcare staff spend monitoring opioid overdose patients given naloxone. Full article

Major depressive disorder (MDD) and other affective disorders may surreptitiously arise in children and adolescents during their school period and impair their social and educational functioning. Besides the social and personal burden, which are increased during the SARS-CoV-2 pandemic, the onset of depression may compromise the future of the growing person with chronicity and recurrence. In this context, educators’ training is essential to detect early the onset of a depressive disorder, to spare later consequences through the timely establishment of adequate treatment. The educational staff should receive adequate training to be able to work closely with healthcare providers and parents, thus directing the young person with an affective disorder to the right psychological and pharmacological treatment provider, i.e., a specialized psychologist or psychiatrist. The first approach should be to establish a trustful relationship with the adolescent and his/her classmates, to reduce social and self-stigma and inform about mental illness. If symptoms do not subside and the suffering child or adolescent fails to reintegrate within his/her school environment, cognitive–behavioral interventions are recommended that are individual, group, or computer-based. When needed, these should be implemented with individualized pharmacotherapy. Full article